ABSTRACT
Background: The data on clinical characteristics, treatment practices and out comes in patients with Nonischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF. Methods: 1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke. Results: Patients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up. Conclusions: Patients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes. Keywords: Non-ischemic systolic heart failure, risk factors, outcomes, guideline directed treatment
ABSTRACT
Background: The data on incidence of recovered Left Ventricular Ejection Fraction (LVEF) and outcome in patients with non ischemic systolic heart failure is limited. We report the incidence, determinants and mortality in patients with recovered LVEF. Methods: The 369 patients with HFrEF with LVEF of less than 40% of non ischemic etiology with available follow up echocardiography study at one year were enrolled. The baseline data of clinical characteristics and treatment was recorded prospectively and were followed up annually for mean of 3.6 years (range 2 to 5 years) to record all cause death and LVEF measured echocardiographically. The recovered, partially recovered and no recovery of LVEF was defined based on increase in LVEF to 50% and more, 41% to 49% and to persistently depressed LVEF to 40% or lower respectively. Results: The LVEF recovered in 36.5%% of the cohort at 5 years. The rate of recovery of LVEF was slower in patients with no recovery of LVEF at one year compared to cohort with partially recovered LVEF (18% vs.53%) at five year. The Baseline LVEF was significantly associated with recovered LVEF, odd ratio (95% C.I.) 1.09(1.04, 1.14). The cumulative mortality at five years was significantly lower in cohort with recovered LVEF (18.1% vs. 57.1%). Conclusions: One third of the patients had recovered LVEF and was significantly associated with baseline LVEF and lower mortality rate.
ABSTRACT
Background: Cardiovascular disease is a major global health problem reaching epidemic proportions. Along with the developed nations, underdeveloped and developing countries are now facing this burden. Keeping this in mind various emerging risk factors in patients with documented evidence of acute myocardial infarction attending a tertiary care hospital in the Kumaon region of Uttarakhand were studied.Methods: This study is a prospective study done in the department of Medicine, Sushila Tiwari Government Hospital, Haldwani over a period of 2 years. Patients were enrolled from the Medical Emergency/ OPD who had documented evidence of Acute Myocardial Infarction. Informed consent was taken from each study subject.Results: The mean age was 54.27 years (SD- 13.062). Among the risk factors, high triglyceride is significantly higher in younger patients as compare to older patients. Lipid profile distribution when they compare to any addiction, it has been found in the study that LDL is significantly higher in those who were having any addiction. Hypertension was significantly higher in patients who smoke (p=0.04). The major contributing risk factor was any addiction (smoking, alcohol, tobacco consumption in any form) followed by dyslipidemia.Conclusions: The challenge is to develop appropriate strategies to prevent coronary artery diseases and promote healthy lifestyles.